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Table 1 Implementation phases for safer smoking supplies at SSPs in the United States, November–December 2023 (n = 118)

From: Implementation determinants of safer smoking supplies in U.S. syringe services programs

 

Pre-implementation phase not specified (n = 3; 2.5%)

Not exploring implementation (n = 13; 11.0%)

Exploring implementation (n = 19; 16.1%)

Preparing to Implement (n = 4; 3.4%)

Currently implementing (n = 79; 66.9%)

Total (N = 118)a

Organizational Characteristics

Region

 Midwestb

0 (0%)

2 (15.4%)

3 (15.8%)

2 (50.0%)

12 (15.2%)

19 (16.1%)

 Northeastc

0 (0%)

1 (7.7%)

2 (10.5%)

0 (0%)

18 (22.8%)

21 (17.8%)

 Westd

1 (33.3%)

3 (23.1%)

7 (36.8%)

1 (25.0%)

36 (45.6%)

48 (40.7%)

 Southe

1 (33.3%)

6 (46.2%)

7 (36.8%)

1 (25.0%)

13 (16.5%)

28 (23.7%)

 Missing

1 (33.3%)

1 (7.7%)

0 (0%)

0 (0%)

0 (0%)

2 (1.7%)

Urbanicity of areas served$

 Urban&

1 (33.3%)

8 (61.5%)

9 (47.4%)

4 (100%)

51 (64.6%)

73 (61.9%)

 Suburban&

0 (0%)

3 (23.1%)

6 (31.6%)

1 (25.0%)

27 (34.2%)

37 (31.4%)

 Exurban/Semi-rural&

1 (33.3%)

1 (7.7%)

3 (15.8%)

0 (0%)

25 (31.6%)

30 (25.4%)

 Rural&

1 (33.3%)

3 (23.1%)

8 (42.1%)

1 (25.0%)

33 (41.8%)

46 (39.0%)

Type of Organization$

 Community-based Organization/Non-profit&

2 (66.7%)

6 (46.2%)

12 (63.2%)

2 (50.0%)

65 (82.3%)

87 (73.7%)

 City, County, or State Health Department&

0 (0%)

7 (53.8%)

7 (36.8%)

1 (25.0%)

16 (20.3%)

31 (26.3%)

Otherf,&

1 (33.3%)

0 (0%)

2 (10.5%)

0 (0%)

3 (3.8%)

6 (5.1%)

Funding sources$

 Federal&

1 (33.3%)

5 (38.5%)

15 (78.9%)

3 (75.0%)

31 (39.2%)

55 (46.6%)

 State&

2 (66.7%)

11 (84.6%)

15 (78.9%)

4 (100%)

66 (83.5%)

98 (83.1%)

 Foundation&

1 (33.3%)

4 (30.8%)

5 (26.3%)

1 (25.0%)

42 (53.2%)

53 (44.9%)

 Private donations from fundraising&

1 (33.3%)

1 (7.7%)

9 (47.4%)

2 (50.0%)

43 (54.4%)

56 (47.5%)

 Otherg,&

2 (66.7%)

3 (23.1%)

3 (15.8%)

3 (75.0%)

22 (27.8%)

33 (28.0%)

Duration of operation

 Less than one year

0 (0%)

0 (0%)

0 (0%)

0 (0%)

2 (2.5%)

2 (1.7%)

 1–2 years

1 (33.3%)

0 (0%)

0 (0%)

0 (0%)

5 (6.3%)

6 (5.1%)

 3–5 years

0 (0%)

3 (23.1%)

4 (21.1%)

1 (25.0%)

16 (20.3%)

24 (20.3%)

 Greater than 5 years

2 (66.7%)

10 (76.9%)

15 (78.9%)

3 (75.0%)

55 (69.6%)

85 (72.0%)

Number of unique clients (past month)

 Median [IQR]

800 [700]

300 [236]

75 [345]

150 [135]

300 [551]

300 [499]

 Unsure or missing

1 (33.3%)

4 (30.8%)

10 (52.6%)

1 (25.0%)

20 (25.3%)

36 (30.5%)

Services offered$

 Naloxone&

2 (66.7%)

13 (100%)

19 (100%)

4 (100%)

79 (100%)

117 (99.2%)

 Syringes&

2 (66.7%)

10 (76.9%)

16 (84.2%)

4 (100%)

77 (97.5%)

109 (92.4%)

 Safer snorting supplies&

0 (0%)

1 (7.7%)

2 (10.5%)

1 (25.0%)

60 (75.9%)

64 (54.2%)

 Anal administration supplies&

1 (33.3%)

3 (23.1%)

5 (26.3%)

1 (25.0%)

52 (65.8%)

62 (52.5%)

 Basic first aid&

2 (66.7%)

11 (84.6%)

18 (94.7%)

4 (100%)

74 (93.7%)

109 (92.4%)

 Food&

1 (33.3%)

6 (46.2%)

9 (47.4%)

2 (50.0%)

52 (65.8%)

70 (59.3%)

 Safer sex supplies&

2 (66.7%)

12 (92.3%)

19 (100%)

4 (100%)

77 (97.5%)

114 (96.6%)

 HIV testing&

1 (33.3%)

11 (84.6%)

13 (68.4%)

3 (75.0%)

56 (70.9%)

84 (71.2%)

 Hepatitis C testing&

1 (33.3%)

10 (76.9%)

12 (63.2%)

3 (75.0%)

51 (64.6%)

77 (65.3%)

 PrEP or PEP for HIV&

0 (0%)

4 (30.8%)

9 (47.4%)

1 (25.0%)

27 (34.2%)

41 (34.7%)

 HIV treatment&

0 (0%)

1 (7.7%)

6 (31.6%)

0 (0%)

17 (21.5%)

24 (20.3%)

 Hepatitis C treatment&

0 (0%)

2 (15.4%)

6 (31.6%)

0 (0%)

19 (24.1%)

27 (22.9%)

 STI testing&

1 (33.3%)

6 (46.2%)

8 (42.1%)

2 (50.0%)

41 (51.9%)

58 (49.2%)

 STI treatment&

0 (0%)

5 (38.5%)

8 (42.1%)

2 (50.0%)

23 (29.1%)

38 (32.2%)

 Basic clinical services&

0 (0%)

7 (53.8%)

7 (36.8%)

1 (25.0%)

27 (34.2%)

42 (35.6%)

 Mental health services&

0 (0%)

3 (23.1%)

11 (57.9%)

1 (25.0%)

20 (25.3%)

35 (29.7%)

 Referrals&

2 (66.7%)

3 (23.1%)

18 (94.7%)

4 (100%)

71 (89.9%)

106 (89.8%)

 Case management/housing coordination services&

0 (0%)

6 (46.2%)

12 (63.2%)

0 (0%)

41 (51.9%)

59 (50.0%)

 MOUD coordination&

0 (0%)

9 (69.2%)

13 (68.4%)

1 (25.0%)

44 (55.7%)

67 (56.8%)

Duration of providing syringesh

 Less than one year

0 (0%)

0 (0%)

2 (10.5%)

0 (0%)

3 (3.8%)

5 (4.2%)

 1–2 years

1 (33.3%)

1 (7.7%)

0 (0%)

1 (25.0%)

8 (10.1%)

11 (9.3%)

 3–5 years

0 (0%)

3 (23.1%)

5 (26.3%)

1 (25.0%)

18 (22.8%)

27 (22.9%)

 Greater than 5 years

1 (33.3%)

6 (46.2%)

9 (47.4%)

2 (50.0%)

44 (55.7%)

62 (52.5%)

 Unsure or missing

1 (33.3%)

3 (23.1%)

3 (15.8%)

0 (0.0%)

6 (7.6%)

13 (11.0%)

Implementation Determinants

Perceived change in demand for smoking supplies (past 6 months)

 Increased

2 (66.7%)

6 (46.2%)

10 (52.6%)

1 (25.0%)

59 (74.7%)

78 (66.1%)

 Decreased

0 (0%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

0 (0.00%)

 Unsure

1 (33.3%)

7 (53.8%)

4 (21.1%)

0 (0%)

1 (1.3%)

13 (11.0%)

 Remained the same

0 (0%)

0 (0%)

5 (26.3%)

3 (75.0%)

15 (19.0%)

23 (19.5%)

Barriers to implementation$

Outer context

 Local policies&

1 (33.3%)

5 (38.5%)

12 (63.2%)

3 (75.0%)

27 (34.2%)

48 (40.7%)

 Federal policies&

1 (33.3%)

2 (15.4%)

7 (36.8%)

3 (75.0%)

24 (30.4%)

37 (31.4%)

 External opposition&

2 (66.7%)

4 (30.8%)

8 (42.1%)

1 (25.0%)

14 (17.7%)

29 (24.6%)

 Fear of external pushback&

2 (66.7%)

6 (46.2%)

7 (36.8%)

2 (50.0%)

18 (22.8%)

35 (29.7%)

 Insufficient funding&

3 (100%)

6 (46.2%)

12 (63.2%)

4 (100%)

46 (58.2%)

68 (57.6%)

Inner context

 Unsure of the evidence&

0 (0%)

3 (23.1%)

3 (15.8%)

0 (0%)

2 (2.5%)

8 (6.8%)

 Internal leadership opposition&

1 (33.3%)

4 (30.8%)

6 (31.6%)

0 (0%)

6 (7.6%)

17 (14.4%)

 Limited awareness of need from staff/leadership&

1 (33.3%)

2 (15.4%)

5 (26.3%)

0 (0%)

9 (11.4%)

17 (14.4%)

 Limited interest from SSP clients&

0 (0%)

1 (7.7%)

0 (0%)

0 (0%)

0 (0%)

1 (0.8%)

 Unsure of best practices for implementation&

0 (0%)

0 (0%)

3 (15.8%)

1 (25.0%)

5 (6.3%)

9 (7.6%)

 Missing

0 (0%)

0 (0%)

0 (0%)

0 (0%)

5 (6.3%)

5 (4.2%)

  1. aPercentage (%) values may not add up to 100% due to rounding
  2. bIncludes: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, Wisconsin
  3. cIncludes: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont
  4. dIncludes: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, Wyoming
  5. eIncludes: Alabama, Arkansas, Delaware, Washington D.C., Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, West Virginia, Puerto Rico
  6. fDefined as tribal affiliated organization, academic healthcare organization, or private or commercial health organization
  7. gDefined as university funding or other
  8. hThis question was only asked of organizations that provide syringes (n = 109)
  9. *P-value is for Fisher’s exact test due to low cell count (≤ 5 observations)
  10. $ Variable was ‘select all that apply’ and therefore cell counts add up to greater than the total number of observations
  11. & ‘Select all that apply’ exposures (e.g., urbanicity) were analyzed as separate binary indicator variables (i.e., presence vs. absence of that category). Because respondents could select multiple categories, each p-value reflects a comparison between those who selected the given category and those who did not (e.g., urban vs. non-urban)
  12. SSP Syringe services program, IQR Interquartile range, HIV Human immunodeficiency virus, PrEP HIV pre-exposure prophylaxis, PEP = HIV post-exposure prophylaxis, STI Sexually transmitted infection, SSP Syringe services program, MOUD Medications for opioid use disorder
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Implementation Science Communications

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